Nagpal A D, Bhatnagar G, Cutrara C A, Ahmed S M, McKenzie N, Quantz M, Kiaii B, Menkis A, Fox S, Stitt L, Novick R J
Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario.
Can J Cardiol. 2006 Aug;22(10):849-53. doi: 10.1016/s0828-282x(06)70303-8.
Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly.
To compare the safety of OPCAB surgery versus CCAB surgery in the octogenarian population of two large southwestern Ontario cardiac surgical units.
Two hundred thirty-six consecutive octogenarians underwent primary isolated coronary artery bypass surgery from November 2000 to March 2005. Patients undergoing OPCAB surgery tended to have higher Parsonnet scores, while patients undergoing CCAB surgery had a greater number of emergent operations. The Canadian Cardiovascular Network predicted that mortality risk was similar in both groups. In-hospital mortality was similar between groups, as was postoperative myocardial infarction and new onset of renal dysfunction. However, in the OPCAB group, there was a decreased incidence of postoperative neurological dysfunction (2.3% in the OPCAB group versus 10.5% in the CCAB group, P=0.01), in particular cerebrovascular accidents (1.5% in the OPCAB group versus 7.6% in the CCAB group, P=0.05), and a decreased incidence of prolonged intubation (5.3% in the OPCAB group versus 13.3% in the CCAB group, P=0.04). Multivariable analysis found that cardiopulmonary bypass had no significant impact on mortality or length of stay.
In octogenarian patients, OPCAB surgery is as safe as CCAB surgery in terms of mortality and major morbidity. Furthermore, a significant reduction in neurological dysfunction and prolonged intubation was seen in the OPCAB group compared with the CCAB group.
非体外循环冠状动脉搭桥术（OPCAB）已成功应用于不同患者群体，并且据推测在包括老年人在内的一些高危患者中，该手术比传统冠状动脉搭桥术（CCAB）更安全。
比较安大略省西南部两个大型心脏外科中心的八旬老人群体中OPCAB手术与CCAB手术的安全性。
2000年11月至2005年3月期间，236例连续的八旬老人接受了初次单纯冠状动脉搭桥手术。接受OPCAB手术的患者Parsonnet评分往往较高，而接受CCAB手术的患者急诊手术数量更多。加拿大心血管网络预测两组的死亡风险相似。两组的住院死亡率相似，术后心肌梗死和新发肾功能障碍的情况也相似。然而，在OPCAB组中，术后神经功能障碍的发生率降低（OPCAB组为2.3%，CCAB组为10.5%，P=0.01），尤其是脑血管意外（OPCAB组为1.5%，CCAB组为7. ;6%，P=0.05），并且气管插管时间延长的发生率降低（OPCAB组为5.3%，CCAB组为13.3%，P=0.04）。多变量分析发现体外循环对死亡率或住院时间没有显著影响。
在八旬老人患者中，就死亡率和主要并发症而言，OPCAB手术与CCAB手术一样安全。此外，与CCAB组相比，OPCAB组神经功能障碍和气管插管时间延长的情况明显减少。
